突發性耳聾病人使用類回醇合併高壓氧治療對於聽力改善是否有效？

Effective in Improving Hearing Recovery for Patients with Sudden Sensorineural Hearing Loss?

突發性耳聾（Sudden Sensorineural HearingLoss, SSNHL），又稱耳中風，是聽力在短時間內急劇下降的疾病，常伴隨耳鳴、耳悶或暈眩。現行治療以類固醇抗炎藥物為主，高壓氧治療（Hyperbaric Oxygen Therapy, HBOT）近年來被視為有效輔助療法，但其與類固醇合併使用的療效仍具爭議。為探討此合併治療的效果，本研究依實證護理方法進行文獻搜尋與分析，最終納入2篇高質量文獻進行評讀。結果顯示，類固醇與高壓氧合併治療在發病7天內效果最佳，顯著優於單一療法。對於50歲以下患者，單獨高壓氧療效更佳；而50歲以上患者則以合併治療為優。女性患者的聽力恢復普遍優於男性，高壓氧治療副作用輕微。建議臨床中根據患者年齡與性別制定個別化治療方案，並採用醫病共享決策（SDM）溝通治療選擇。早期採用類固醇合併高壓氧治療可顯著提升聽力恢復，特別是在黃金治療期內施治的患者，療效更為顯著。
臨床情境
突發性耳聾（俗稱耳中風），正確名稱為突發感音神經性聽力損失，是一種聽力突然降低的疾病，患者可能在一覺醒來後，發現一側聽力減弱、耳鳴、耳悶感、甚至合併暈眩等。在疾病的定義上，突發性耳聾是指在聽力圖上連續三個頻率感覺神經性聽力下降超過30分貝（通常與對側耳比較），且此情況是在最近三日內發生的（廖、秦，2022）。根據研究報告顯示造成突發性耳聾的最常見原因，可能是血管因素導致之組織缺血或病毒感染導致之神經炎，其它病因如內耳迷路膜之破損或聽神經瘤則非常少見。現階段突發性耳聾在治療上仍以抗發炎藥物改善血液循環及組織灌流為原則，常見以類固醇藥物治療，其它治療包括靜脈輸液、血漿擴張劑、末梢血管舒張劑、臥床休息等（林等，2020）。近年來有許多文獻研究報告，都支持高壓氧氣用於突發性耳聾之輔助治療，然而研究發現，比較使用類固醇及高壓氧治療突發性耳聾患者，聽力程度恢復無顯著差異（Kuo et al., 2022; Leiet al., 2021），故想進一步探討，將藉由實證手法搜尋相關文獻，並仔細評讀文章探討突發性耳聾病人使用類固醇合併高壓氧治療對於聽力改善是否有效？

Sudden Sensorineural Hearing Loss (SSNHL), also known as an“ear stroke,”is a condition characterized by a rapid decline in hearing, often accompanied by tinnitus, ear fullness, or vertigo. Current treatments primarily involve corticosteroids to reduce inflammation, while hyperbaric oxygen therapy (HBOT) has recently been recognized as a potentially effective adjunctive treatment. However, the efficacy of combining HBOT with corticosteroids remains controversial.
To investigate the effectiveness of this combined therapy, this study utilized evidence-based nursing methods to conduct a literature review and analysis. Two high-quality studies were ultimately included. Results revealed that combining corticosteroids with HBOT yielded the best outcomes when initiated within seven days of onset, significantly outperforming monotherapy. For patients under 50 years old, HBOT alone was more effective, while for those over 50, the combined therapy was superior. Female patients generally exhibited better hearing recovery than males, and HBOT-related side effects were minimal, with only mild ear discomfort reported in rare cases.
It is recommended that clinical practice tailor treatment plans based on patient age and gender while employing shared decision-making (SDM) to facilitate discussions about therapy options. Early adoption of combined corticosteroid and HBOT treatment can significantly enhance hearing recovery, particularly for patients treated during the critical therapeutic window, where outcomes are most pronounced.